Anatomy Sessions Research Articles

Factors influencing students' decisions to participate in a short “dissection experience” within a systemic anatomy course

Changes in medical education have affected both curriculum design and delivery. Many medical schools now use integrated curricula and a systemic approach, with reduced hours of anatomy teaching. While learning anatomy via dissection is invaluable in educational, professional, and personal development, it is time intensive and supports a regional approach to learning anatomy; the use of prosections has replaced dissection as the main teaching method in many medical schools. In our graduate-entry medical degree, we use an integrated curriculum, with prosections to teach anatomy systemically. However, to not exclude dissection completely, and to expose students to its additional and unique benefits, we implemented a short "Dissection Experience" at the beginning of Year 2. Students attended three two-hour anatomy sessions and participated in dissection of the clinically relevant areas of the cubital fossa, femoral triangle, and infraclavicular region. This activity was voluntary and we retrospectively surveyed all students to ascertain factors influencing their decision of whether to participate in this activity, and to obtain feedback from those students who did participate. The main reasons students did not participate were previous dissection experience and time constraints. The reasons most strongly affecting students' decisions to participate related to experience (lack of previous or new) and new skill. Students' responses as to the most beneficial component of the dissection experience were based around practical skills, anatomical education, the learning process, and the body donors. We report here on the benefits and practicalities of including a short dissection experience in a systemic, prosection-based anatomy course.

Medical Students' Exposure to Urology in the Undergraduate Curriculum, a Web Based Survey

Objective: Urological knowledge and skills are lacking in junior doctors and Urology is undersubscribed for specialist training. Lack of exposure as undergraduates may be responsible. We aimed to assess Urology exposure, confidence about managing common conditions and career prospects, in current UK medical students. Methods: All UK medical schools were contacted. Final year students were asked to complete an online survey about Urology. Results: 610 responses were received. Only 42% of respondents had a compulsory clinical attachment in Urology, lasting on average 1 week. 46% had compulsory attachments partially based in Urology, mainly with other surgical specialities. Common urological activities had been attended by >50% of respondents, however 6% had not attended any. Over 80% of respondents received teaching on common Urology topics except for urological emergencies (62%). Lectures and anatomy sessions were the main teaching methods. 87% of teaching was from Urologists. Most respondents felt ‘confident’ managing common urological problems, but 32% felt ‘not very confident' with urological emergencies. Only 14% of respondents would consider a career in Urology. Conclusion: Urology experience is not compulsory in UK medical schools and is variable. Final year students lack confidence managing urological emergencies and have limited interest in Urology as a career. Development of a Urology undergraduate curriculum should help address these issues.

Incorporating Gross Anatomy Education Into Radiation Oncology Residency: A 2-Year Curriculum With Evaluation of Resident Satisfaction

Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction.

Anatomical Sciences Education vol.3, issue 3, 2010 cover image

AbstractMedical students at the University of Hong Kong learn about the development of the gastrointestinal tract using the “midgut‐rotation apron” worn by their gross anatomy instructor. The midgut, represented by a tube attached to the apron, can be pulled out and manipulated to simulate the elongation and rotation of the midgut. In this issue of ASE, Dr. Lap Ki Chan shares his experiences using this and other simple tools to promote active learning during gross anatomy sessions.

Commentary: The Importance of Musculoskeletal Medicine and Anatomy in Medical Education

Medical schools in the United States have continued to demonstrate deficiencies in musculoskeletal education. In response to the findings of numerous studies and to the objectives of the U.S. Bone and Joint Decade (an international collaborative movement sanctioned by the United Nations and the World Health Organization for the purpose of promoting awareness of musculoskeletal disease), several institutions, including Harvard Medical School, have reassessed the preclinical musculoskeletal curriculum at their respective medical schools. A cross-sectional survey at Harvard in 2004 found that students lacked clinical confidence in dealing with the musculoskeletal system. In addition, only one quarter of the graduating class of medical students passed a nationally validated exam in basic musculoskeletal competency. In 2005, 33 total hours of musculoskeletal medicine were added to the musculoskeletal blocks of the preclinical anatomy, pathophysiology, and physical examination courses. Alongside this movement toward more musculoskeletal education, there has been continued debate over the relevance and cost-effectiveness of cadaveric and surface anatomy labs. With the advent of advanced imaging technology, some argue that dissection anatomy is outdated and labor-intensive, whereas three-dimensional images are more accessible and time-effective for today's students. However, knowledge of anatomy is a critical foundation to learning musculoskeletal medicine. Thus, making room for more musculoskeletal curriculum time by cutting out cadaveric anatomy labs may ultimately be counterproductive.

Adding anatomy to the medical clerkships: experience with surgery and clinical skills

Reduced time for anatomy in the first year medical curriculum challenges anatomists to provide students with opportunities to learn the anatomy that is essential for clinical practice. One way to meet this challenge is to integrate specific topics of anatomy into the third year when they are clinically relevant. Previously we determined that third year students prefer a combination of demonstration by an instructor and “hands‐on” work with a cadaver to learn anatomy. More recently, we consulted with clinical colleagues to develop “need to know” clinical anatomy sessions that are now required for third year students in both the Surgery clerkships and in the Clinical Skills Immersion Experience (CSIE). Prosections are used to review specific anatomical relationships that are relevant to general surgery and to selected invasive procedures. Groups of 35 students rotate among the prosections and are assisted by anatomy staff or are self‐guided by exercises on computers. In the 2‐day CSIE, students first review relevant anatomy and then practice selected invasive procedures, e.g., chest tubes, paracentesis, thoracentesis, and kidney biopsy on unembalmed cadavers. Students report that they are “very satisfied” with these anatomy sessions. Invasive procedure training using unembalmed cadavers is greatly appreciated as it reduces anxiety and provides an authentic experience that cannot be matched using models.

Should Forensic Autopsies Be a Source for Medical Education? A Preliminary Study

Background: Practical anatomy sessions including dissection of cadavers are essential for anatomy courses. There are many difficulties in obtaining cadavers. In addition, hardened and discolored cadavers that are fixed with formaldehyde look unrealistic and generate apathy among students. Purpose: We considered that forensic autopsies may be used as ancillary and supportive practice in anatomy education. Methods: We invited the participation of Year 2 medical students in suitable forensic autopsy cases during the course of one year. Specialists of forensic medicine and anatomy provided theoretical support through talks in their specialized fields during the autopsy. At the end of the semester, feedback questionnaire forms were prepared and the students were asked to evaluate these sessions. Results: Forty students participated in the evaluation by completing the questionnaire. Students made positive statements about adequacy of the time of the application, consistency of the structures with theoretical and practical issues shown in anatomy lectures, and necessary explanations of the lecturers during and after the application. Conclusion: We think that forensic autopsies are an attractive supplementary educational model, and we have decided to continue the forensic autopsy practices. We believe that further studies on the evaluation of the sessions using a larger student population will lead to more conclusive results.

A Unique, Innovative, and Clinically Oriented Approach to Anatomy Education

The establishment of The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, whose first class entered in 2004, provided a unique opportunity to design an anatomy program that, from all indications, is effective, time efficient, and clinically relevant in the context of a nonlecture, problem-based, organ-systems-oriented curriculum. Through consultation with surgery colleagues, the case-directed anatomy program was developed. This approach, meeting one day a week for 1 hour 50 minutes for 30 weeks, uses clinical cases to introduce anatomical information that is reinforced using prosected cadavers and imaging. The format of the approach involves three steps: (1) students preview a clinical case with clinical questions and learning objectives, (2) students acquire basic knowledge using textbooks and self-directed learning modules, and (3) students reinforce their basic knowledge in weekly case-directed anatomy sessions, which involve an interactive discussion of the clinical case followed by a laboratory. In the laboratory, students rotate around stations viewing prosected cadavers and imaging. Learning anatomy does not stop after the first year, because the program is longitudinal. During the second year, students review anatomy in each organ-system course using the first-year format. Also, second-year students can assist the fellows or residents prepare the prosections for first-year students and for their review of anatomy in the second year. This provides students with a dissection experience. During third-year clinical rotations, anatomy knowledge is reinforced, and several surgery anatomy electives are available during the final year. In this way, anatomy is learned and reinforced throughout the medical school curriculum.

Talking Points: Incorporating Team Learning Strategies into the Microscopic Anatomy Curriculum

Active learning has the benefit of being more engaging and interactive, making it more suitable for adult learners who prefer a task/problem centered approach to learning. Implementation of small-group sessions in the material-rich course is not always possible and other alternatives that engage learners should be explored. To incorporate active learning strategies, a team learning exercise “Talking Points” (TP), was introduced in a microscopic anatomy sessions for first year medical students. At the beginning of the laboratory period, students were given 5–7 subject-related basic science/clinical problems and were encouraged to discuss within small “ad hoc” formed teams. Near the end of the laboratory session, these items were discussed by the entire group. This exercise gave the students the opportunity to learn relevant clinical material within small teams and present their findings to other classmates. Many students remarked that TP facilitated their learning of the material, stimulated questions, encouraged peer teaching, and provided a preview of learning strategies for the final examination. The participation and students' performance during TP was not included in the final grade. Incorporation of the TP into the microscopic anatomy curriculum increased students' participation and ended the laboratory session with an enthusiastic conclusion.

Integration of ultrasound in the education programme in anatomy

Context and setting Medical students invest a significant amount of time studying human structure using a variety of resources. They often find it challenging to visualise the functioning living human and to apply their learning clinically. Because ultrasound imaging provides a means of visualising structure and movement in a living person, it was proposed that it could be used to enhance and facilitate the learning of functional clinical anatomy. An ultrasound learning resource was located within the anatomy area to enable students to integrate their learning through ultrasound with the study of specimens and other resources. Why the idea was necessary The purpose of the study was to determine the effect on student learning of integrated ultrasound anatomy teaching sessions. These sessions included an introduction to the technology of ultrasound imaging and the hands-on experience of performing an examination in order to provide students with the opportunity to develop basic imaging skills, and to enhance their knowledge of surface and visceral anatomy. What was done Groups of 6 first-year medical students had an integrated clinical skills, anatomy and radiology session, followed by a series of 3 90-minute ultrasound anatomy sessions provided by a radiologist during the cardiovascular and renal subunits. The sessions included an introduction to the use of the ultrasound imaging, the setting of learning objectives, guidance on the location of landmarks and the visualisation of organs and tissues, a hands-on experience conducting an ultrasound examination on a living human, a discussion of its clinical relevance and an evaluation of the session. The objectives of the examinations were to use various approaches and scans to visualise and identify specific cardiac structures, major abdominal vessels, carotid arteries and the kidneys, as well as noting the relationships of adjacent structures. Videos of related pathologies were also discussed. The students were evaluated on their ability to perform an ultrasound examination at the end of the first and the last sessions, and received formative evaluation. For this study, a 5-point scale was used: from 1 = poor (inadequate identification of ‘acoustic window’ required for visualisation of prioritised structures) to 5 = excellent (ability to detect normal and pathological surface anatomy and functional morphology on reference standards). Approximately 490 medical students from 4 consecutive classes participated. The average score at the end of the first session was 3.25 ± 0.12, compared to the last session (4.15 ± 0.16; P < 0.005). The scores from this study were not provided to the students or incorporated into their formal evaluation. The student evaluations of the sessions were consistently excellent (score of 5/5), and included highly positive comments. Evaluation of results and impact The results of this study show that the small-group problem-based ultrasound anatomy sessions for students in the Medical Program at McMaster University, which focuses on small-group problem-based active learning, are a highly effective method for facilitating student learning and significantly enhance knowledge of living clinical anatomy. In addition, they provide students with a basic understanding of ultrasound imaging and its use in clinical practice. Finally, the students value these innovative sessions highly and find that this use of ultrasound is an exciting and engaging approach to stimulate the learning of ‘living’ clinical anatomy and enhance their clinical reasoning skills.

Teaching of anatomy in a problem-based curriculum at the Arabian Gulf University: the new face of the museum.

The College of Medicine and Medical Sciences of the Arabian Gulf University has an undergraduate medical curriculum that uses problem-based learning as the principal teaching strategy. Teaching of anatomy comes at various places in the curriculum, and the anatomy museum serves as an important resource and engages the students in self-directed learning. Although the museum had sufficient resource materials, the emphasis on individualized instruction and self-directed learning in anatomy has resulted in the need for an effective approach and a reorganization of the facilities in the museum. Thus, we recently rearranged the museum to create 42 modules or stations (learning carrels) focusing on specific organ systems for self-study by students. Computer-assisted programs, videocassettes, ultrasound, and structured living anatomy sessions in the clinical professional skills program facilitated such an arrangement. An increased utilization by the students was observed in the reorganized museum. Thus, the museum can play an effective role in the study of anatomy through problem-based integrated learning modules.

Las sesiones anatomoclínicas en México en los albores del siglo XXI

The authors present a defense of postmortem clinical anatomy sessions, which contributed enormously to the development of clinical medicine but which today draw little interest in medical studies. Nevertheless, the sessions still provide an unrivalled exercise in diagnosis for medical students and an excellent method of continuing education for practicing professionals. Autopsies make it possible to confirm or correct clinical diagnoses, including those obtained through highly complex technological procedures; they contribute to the discovery of new diseases and other abnormalities; they promote research; they provide reliable statistics on morbidity and mortality; they produce useful genetic information; they facilitate interdisciplinary discussion and knowledge exchange; and they can serve as an indicator of the quality of medical care. The authors recommend reviving the high academic standards of postmortem clinical anatomy sessions and urge professionals in health institutions to contribute as much as possible to the continuation and improvement of these sessions.

Infiltrating the curriculum: an integrative approach to history for medical students.

I believe that the purpose of history in a medical school can be related to two simple goals: first, to make students a bit skeptical about everything else they are to be taught in the other lectures--skepticism fosters humility and life-long learning; second, to make them aware that medical history is a research discipline as compelling as any of the basic and clinical sciences they are traditionally taught. In the fall of 1988, I was given an opportunity to build a "course" in history for medical students--a course with no fixed time slot, no fixed syllabus, and no fixed content. I wanted to teach history of anatomy during anatomy sessions, history of pathology during pathology, history of obstetrics during obstetrics, and so on. I hoped to end each session with a disciplinary controversy that extended into present practice. The ultimate manifestation of infiltration would be to have one question on every exam that the students would write during their medical school experience. This is the story of how my medical history teaching moved from nothing to a program integrated throughout four years of medical studies, complete with goals and objectives and two questions of every exam. The content, advantages, and problems of the approach in the Queen's University experience will be presented.